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CHAPTER OBJECTIVES

Describe the anatomy of the joints, ligaments, muscles, and blood and nerve supply comprising the elbow complex.

Describe the biomechanics of the elbow complex, including open- and close-packed positions, normal and abnormal joint barriers, force couples, and stabilizers.

Describe the purpose and components of the tests and measures for the elbow complex.

Perform a comprehensive examination of the elbow complex, including palpation of the articular and soft-tissue structures, specific passive mobility, and passive articular mobility tests, and stability tests.

Evaluate the total examination data to establish a prognosis.

Describe the relationship between muscle imbalance and functional performance of the elbow.

Outline the significance of the key findings from the tests and measures and establish a diagnosis or working hypothesis.

Summarize the various causes of elbow dysfunction.

Develop self-reliant intervention strategies based on clinical findings and established goals.

Describe and demonstrate intervention strategies and techniques based on clinical findings and established goals.

Evaluate the intervention effectiveness in order to progress or modify an intervention.

OVERVIEW

The elbow serves an important linkage function that enables proper positioning of the hand and the transmission of power from the shoulder to the hand, thus augmenting the versatility and agility of the upper extremity. Unlike the shoulder, the elbow complex is an inherently strong and stable joint, because of the interrelationship of its articular surfaces and ligamentous constraints. However, the stability of the elbow complex allows little in the way of compensatory adjustments, making it particularly vulnerable to overuse injury from repetitious muscle activity and sudden movements of acceleration and deceleration. Appropriate diagnosis and treatment require a detailed understanding of the normal anatomy of the elbow.

ANATOMY

The elbow complex, enclosed within the capsule of the cubital articulation, is composed of three distinct articulations: the humeroulnar joint, the humeroradial joint, and the proximal radioulnar joint. The anterior joint capsule of the elbow originates from the distal humerus proximal to the radial and coronoid fossa, from where it then inserts distally into the rim of the coronoid and the annular ligament (AL).1 Posteriorly, the capsule incorporates the area proximal to the olecranon process; it attaches distally along the articular margin of the sigmoid notch and the proximal aspect of the olecranon fossa.2

The joint capsule of the elbow complex is thin but strong and is reinforced medially and laterally by ligaments. Anteriorly, the capsule contributes 38% of the resistance to valgus force and 32% of the resistance to varus force in full extension.3 The capsule of the joint does not respond well to injury or prolonged immobilization and often forms thick scar tissue, which may result in flexion contractures of the elbow.4–6